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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.
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PMID:Geriatric considerations in the diagnosis and management of overactive bladder. 1249 54

Postural medicine studies the effects of gravity on human body functions and the ability to influence various diseases by changing the body's position. Orthostasis requires numerous cardiovascular and neurohumoral adaptations to prevent hypotension and a resulting decrease in cerebral perfusion. Sitting upright or in a semi-sitting position reduces venous return in patients with heart failure, intracranial pressure in patients with intracranial hypertension, intraocular pressure in glaucoma patients and may decrease gastro-oesophageal reflux. A left recumbent posture also decreases reflux. A right lateral position results in a lower sympathetic tone than lying on the left side and is beneficial in patients with heart failure or after an infarction without bradycardia. A 40 to 70% decreased prevalence of the sudden infant death syndrome has been observed since the recommendation to avoid laying infants to sleep in a prone position. Sleeping in a supine posture increases the severity of sleep apnoea compared to a lateral position. In patients with acute respiratory distress syndrome, a prone position can rapidly improve blood oxygenation. Idiopathic oedema, orthostatic proteinuria, intradiscal pressure and venous circulation in legs are improved in the decubitus position, whereas arterial flow is reduced. Health risks due to microgravity and prolonged bed rest, such as osteoporosis, venous thrombosis or pressure sores, are discussed.
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PMID:The role of body position and gravity in the symptoms and treatment of various medical diseases. 1555 Nov 57

An 89-year-old female resident in the assisted living section of a continuing care retirement community complained of dizziness and lightheadedness at 10 am daily and was experiencing frequent falls. The facility staff requested a consultant pharmacist perform an extensive review of her medications and medical conditions. Following a chart review and interview with the resident, the consultant pharmacist found that her past medical history consists of coronary artery disease, atrial fibrillation, congestive heart failure, hypertension, dyslipidemia, osteoporosis, gastroesophageal reflux disease, glaucoma, mild dementia, overactive bladder, and Parkinson's disease (PD). The nursing staff monitored the resident's blood pressure during these episodes and determined that the resident was experiencing orthostatic hypotension (OH). During the review, the consultant pharmacist found a recent neurology note that concluded the resident may have multiple-system atrophy (MSA) and her therapy for PD may not be beneficial. As autonomic dysfunction is a common feature of MSA, it is important to minimize the use of medications that can cause or aggravate OH. Additionally, data suggest only a modest and nonsustained response to levodopa in patients with MSA. Therefore, the pharmacist recommended multiple medication changes as well as follow-up monitoring by the patient and assisted living community staff to minimize medication-related problems such as falls.
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PMID:Multiple-system atrophy and medications: how to minimize the risk of falling. 2414 45

Playing a musical instrument can affect physical and mental health. A literature review was conducted to determine the prevalence of health problems among oboists, which medical conditions can be caused or exacerbated by playing, whether oboe playing can be a protective factor, and whether recommendations are possible as to who should or should not play the oboe. Searches in 7 databases (Medline, Embase, Cochrane Library, Web of Science, SocIndex, PsyIndex, Psychinfo) yielded a total of 950 studies; after exclusion of duplicates and those not meeting eligibility criteria, 37 articles were selected for final analysis. In addition, Google Scholar and a musicology library served as additional sources, revealing another 6 publications for inclusion. As a result, some evidence was found for musculoskeletal problems, focal dystonia, stress velopharyngeal incompetence, increased intraocular pressure and glaucoma, gastroesophageal reflux disease, lower pulmonary function, disease transmission via instruments, and hearing loss due to noise exposure. Playing the oboe may be protective against obstructive sleep apnea. However, due to small sample sizes, uncertain reproducibility of findings, and lack of accurate descriptions of problems reported by oboists, far more evidence would be necessary to answer the research questions conclusively. There was no evidence for causal relationships, and thus no recommendations can be made regarding who should (not) play the oboe. To improve the quality of medical care for these musicians and to implement prevention strategies, future investigations with more in-depth instrument-specific analyses and higher numbers of participants are needed.
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PMID:Medical Issues in Playing the Oboe: A Literature Review. 2923 58